Provider Demographics
NPI:1851354674
Name:SHADUR, CRAIG ALAN (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:SHADUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1409
Mailing Address - Country:US
Mailing Address - Phone:515-241-5710
Mailing Address - Fax:515-241-8004
Practice Address - Street 1:1215 PLEASANT STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1409
Practice Address - Country:US
Practice Address - Phone:515-241-5710
Practice Address - Fax:515-241-8004
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20221207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0030403Medicaid
IAA03458Medicare UPIN
IA25261Medicare ID - Type Unspecified